腹腔镜老年胆囊切除术联合胆总管探查取石术98例分析

目的探讨腹腔镜下胆总管探查取石术(LCBDE)联合胆囊切除术(LC)对老年胆囊结石合并胆总管结石的临床效果,为此类疾病的临床治疗提供新的参考。 方法采用前瞻性研究的方法对2012年1月至2016年12月收治的老年胆囊结石合并胆总管结石患者98例进行研究,随机分为LCBDE＋LC组49例和ERCP/EST＋LC组49例;LCBDE＋LC组给予LCBDE＋LC手术治疗,ERCP/EST＋LC组患者采取内镜逆行胆管造影/内镜下括约肌切开取石术(ERCP/EST)联合LC手术治疗。采用SPSS 21.0进行统计分析,手术成功率、结石残存率、并发症发生率等组间比较卡方检验分析;术中术后的各项指标的计量资料采用均数±标准差表示,组间比较采用t检验;P<0.05差异有统计学意义。 结果LCBDE＋LC与ERCP/EST＋LC组比较：手术成功率、复查后结石残留率组间比较差异无统计学意义(P>0.05),提示两种手术方法效果相当。LCBDE＋LC组术中术后各项指标显著优于ERCP/EST＋LC组(P<0.05);术后并发症发生率低于ERCP/EST＋LC组,提示LCBDE＋LC组手术安全性高于对照组患者(P<0.05)。 结论采用LCBDE＋LC与ERCP/EST＋LC治疗老年胆囊结石合并胆总管结石的临床疗效相当,但LCBDE＋LC手术方法的安全性更好,手术时间短、出血量少且手术费用低,可作为老年胆囊结石合并胆总管结石临床治疗的首选方法之一。     

不同微创方法治疗胆囊合并胆总管结石的对比分析

探讨两种不同微创方式治疗胆囊合并胆总管结石的效果。选择胆囊合并胆总管结石患者98例,分为观察组和对照组,每组49例。观察组采用腹腔镜胆囊切除联合胆道镜取石(LC+LCBDE),对照组采用腹腔镜胆囊切除联合内镜下逆行胰胆管造影及乳头括约肌切开取石术(LC+EST)。观察两组手术时间、出血量、取石成功率、中转开腹率、住院时间、住院总费用、术后并发症发生率。观察组手术时间、出血量、住院时间、住院总费用均少于对照组(P均0.01);而取石成功率、中转开腹率及术后并发症发生率两组差异均无统计学意义(P均0.05)。LC+LCBDE与LC+EST两种微创术式治疗胆囊结石合并胆总管均安全有效,但LC+LCBDE在缩短住院时间及减少住院费用等方面更具优势。     

两种微创术式治疗胆囊结石并胆总管结石的比较

目的:评价腹腔镜胆囊切除、胆总管探查取石术（LC+LCBDE）与内镜下Oddi括约肌切开联合腹腔镜胆囊切除术（EST+LC）两种术式治疗胆囊结石合并胆总管结石的临床效果。方法:胆囊结石合并胆总管结石256例分别采用LC+LCBDE和EST+LC治疗，其中LC+LCBDE术治疗132例、EST+LC术治疗124例，比较两组的并发症发生率、手术总时间、住院费用、住院天数。结果:两种术式的近期并发症发生率、结石残留率、平均住院天数比较，差异无统计学意义（P＞0.05）；EST+LC组手术总时间、手术费用均明显高于LC+CLBDE组（P＜0.0l）。结论:两种术式各有其适应证和优缺点。胆总管直径＜1.0cm、胆总管中下端结石或老年胆石症患者宜采用EST+LC术式；胆总管直径＞1.0cm的多发性较大结石、尤其是中青年患者应首选LC+LCBDE术式。     

两种方法治疗胆囊结石合并胆总管结石的临床对比:附82例报告

目的:比较腹腔镜下胆囊切除联合胆总管切开(LC+CBDE)与胆囊切除联合十二指肠镜乳头切开取石术(LC+EST)治疗胆囊结石合并胆总管结石的效果。方法:将82例胆囊合并胆总管结石患者随机分为LC+CBDE组和LC+EST组,进行相应术式治疗并回顾分析:⑴手术成功率、住院时间及费用;⑵术后并发症、结石残留率、复发率。结果:⑴LC+CBDE组和LC+EST组的手术成功率为100%和97.7%(P>0.05);⑵LC+CBDE组的住院时间、治疗费用、结石残留率、并发症发生率、累积结石复发率均低于LC+EST组(P<0.01~0.05)。结论:LC+CBDE治疗胆囊合并胆总管结石的效果较好。     

胆总管结石合并胆囊良性疾病患者微创术式选择分析

目的探讨胆总管结石合并胆囊良性疾病患者不同微创术式治疗效果。方法收集2013年1月~2017年6月医院收治的60例胆总管结石合并胆囊良性疾病患者的临床资料,其中接受腹腔镜胆总管探查术(LCBDE)32例(LCBDE组),接受内镜下十二指肠乳头括约肌切开术(EST)+腹腔镜胆囊切除术(LC)28例(EST+LC组),比较患者围术期情况、手术并发症发生率及术后恢复情况。结果 (1)LCBDE组手术成功率为96.88%,EST+LC组手术成功率为89.29%,两组手术总成功率比较差异无统计学意义(P0.05)。(2)LCBDE组住院时间短于EST+LC组,住院费用低于EST+LC组(P0.05)。(3)术后不同时间LCBDE组视觉模拟评分(VAS)均低于EST+LC组(P0.05),其应用镇痛药物所占比例低于EST+LC组(P0.05)。(4)两组术后结石残留、复发率比较差异无统计学意义(P0.05)。结论 LCBDE与EST+LC治疗胆总管结石合并胆囊良性疾病均有肯定的疗效,术后并发症发生率相近,均微创,安全,但LCBDE术可缩短患者住院时间,减少术后疼痛程度,减少医疗费用。     

两种微创术式治疗胆囊结石合并胆总管结石的效果观察

目的观察腹腔镜胆囊切除术(LC)+胆总管探查取石术(LCBDE)与内镜逆行胰胆管造影(ERCP)/内镜十二指肠乳头括约肌切开术(EST)+腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石的临床疗效。方法采用LC+LCBDE治疗40例,实施ERCP/EST+LC治疗50例。对90例胆囊结石合并胆总管结石患者的临床治疗资料进行回顾性分析。比较两种术式的手术成功率、手术时间、住院时间、结石清除率及并发症发生率。结果 2种术式的手术成功率、手术时间、结石清除率及并发症发生率比较,差异均无统计学意义(P0.05)。但LC+LCBDE的住院时间短于ERCP/EST+LC,差异有统计学意义(P0.05)。结论 LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石均有微创、结石清除率高、术后并发症少等优点,但LC+LCBDE术后恢复时间更短。应根据患者病情及术者的操作熟练程度综合分析,合理选择治疗方法。     

腹腔镜内窥镜治疗胆囊结石合并胆总管结石两种术式的临床分析

目的 评价腹腔镜胆囊切除、胆总管探查取石术(LC+LCBDE)与内镜下Oddi括约肌切开、腹腔镜胆囊切除术(EST+LC)两种术式治疗胆囊结石合并胆总管结石的临床效果.方法 回顾总结LC联合治疗胆囊结石合并胆总管结石256例,采用LC+LCBDE术132例、EsT+LC术124例治疗的临床资料,对两组病例的手术成功率、并发症发生率、手术总时间、住院费用、住院日进行对比统计分析.结果 两种术式的手术成功率、并发症发生率、平均住院日无显著性差异(P>0.05),手术总时间、手术费用比较有显著性差异(P<0.01).结论 两种术式各有其适应证和优缺点.胆总管直径<1.0 cm、胆总管中下端结石或老年胆石症病人宜采用EST+LC术式;胆总管直径>1.0 cm的多发性较大结石、尤其是中青年病人应首选LC+LCBDE术式.     

腹腔镜内窥镜治疗胆囊结石合并胆总管结石两种术式的临床分析

目的 评价腹腔镜胆囊切除、胆总管探查取石术(LC+LCBDE)与内镜下Oddi括约肌切开、腹腔镜胆囊切除术(EST+LC)两种术式治疗胆囊结石合并胆总管结石的临床效果.方法 回顾总结LC联合治疗胆囊结石合并胆总管结石256例,采用LC+LCBDE术132例、EsT+LC术124例治疗的临床资料,对两组病例的手术成功率、并发症发生率、手术总时间、住院费用、住院日进行对比统计分析.结果 两种术式的手术成功率、并发症发生率、平均住院日无显著性差异(P>0.05),手术总时间、手术费用比较有显著性差异(P<0.01).结论 两种术式各有其适应证和优缺点.胆总管直径<1.0 cm、胆总管中下端结石或老年胆石症病人宜采用EST+LC术式;胆总管直径>1.0 cm的多发性较大结石、尤其是中青年病人应首选LC+LCBDE术式.     

腹腔镜胆囊切除联合胆总管探查及内镜括约肌切开治疗胆囊结石并胆总管结石的疗效对比

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查取石术(laparos copiccommon bile duct exploration,LCBDE)与LC联合内镜括约肌切开(endoscopic sphincterotomy,EST)取石术治疗胆囊结石合并胆总管结石的疗效。方法:回顾分析2009年1月至2011年12月247例胆囊结石合并胆总管结石患者的临床资料,其中91例行LC+LCBDE,156例行LC+EST;对比两种术式手术时间、中转开腹率、术后并发症、残石率、住院时间及住院费用等。结果:LC+LCBDE组手术时间短、术后并发症少、住院费用低,但住院时间稍长,两组中转开腹率、残石率差异无统计学意义。结论:LC联合LCBDE及LC联合EST治疗胆囊结石合并胆总管结石安全、可靠。应根据患者具体情况进行个体化治疗,病情允许时LC联合LCBDE可作为首选。     

两种微创手术治疗胆囊结石合并胆总管结石的临床效果比较

目的探讨两种不同微创手术方式治疗胆囊结石合并胆总管结石的临床效果。方法胆囊结石合并胆总管结石患者83例,其中采用腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)(LC+LCBDE组)治疗胆囊结石合并胆总管结石的患者46例,内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)及乳头括约肌切开取石术(endoscopic sphincterotomy,EST)ERCP/EST+LC(ERCP/EST+LC组)治疗胆囊结石合并胆总管结石的患者37例,比较两组患者的临床治疗情况,包括手术成功率,中转开腹率,术后并发症的发生率,近期结石复发率,住院费用及时间等。结果两组患者的手术成功率(93.5%vs 89.2%),中转开腹率(6.5%vs 5.4%),术后并发症的发生率(8.7%vs 8.1%),近期结石复发率比较(5.2%vs 7.4%),差异均无统计学意义(P0.05),手术时间,住院时间及治疗费用等比较差异有统计学意义(P0.05)。结论 LC联合LCBDE与LC联合ERCP/EST对于治疗胆囊结石合并胆总管结石同样有效,LC联合ERCP/EST可缩短手术时间,但在住院时间及治疗费用方面不如LC联合LCBDE,两种微创方式都有其各自的适应证,应根据患者情况制定个体化的治疗方案。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。